health

Rutgers School of Nursing. “It is not
enough for nurse practitioners to note
that the treatment plan for a patient
with diabetes lowered the measure for
elevated blood sugar; [he or she] has to
be able to pull together all the data, analyze it and demonstrate how this plan
will benefit other patients, too.”

For some nurse practitioners like Jon
Sugarman, a successful businessman,
the profession is a second career. “I
wanted to help older patients meet the
challenges my aging parents had faced,”
says Sugarman, who spent seven years
working toward his master’s in nursing
and doctorate in nursing practice. He is
now a member of the Summit Medical
Group Behavioral Health and Cognitive
Therapy Center team.

“Emergency room visits are not onlycommon, but disorienting and oftenfrightening for older people,” addsSugarman, a gerontological nurse practi-tioner. “Every elderly person needs anadvocate in an emergency departmentwho can help patients and their familiesclarify the goals for care and shape thetreatment plans accordingly.”In ;;;;, people over ;; had the high-est rate of emergency room visits—;;.;percent—in the United States, accordingto the National Hospital AmbulatoryMedical Care Survey.

“Unlike younger people, many olderpatients are not going to get better, sowe must consider what can be done togive them the best quality of life,” saysSugarman. “Palliative care that focuseson comfort may be better than aggres-sive treatments. End-of-life issues mustalso be addressed.”Like Sugarman, Dodi Iannaco,manager of clinical practitioners atVirtua Express Urgent Care, became anurse practitioner because she wantedto empower patients. One of the largestnonprofit health care systems in south-ern New Jersey, Virtua includes nineurgent-care centers, which treat about;;,;;; patients a year.

“I loved being a sta; nurse at a hospi-tal, but I didn’t see myself doing that for-ever,” says Iannaco. “I wanted to work ina setting that would demand not only ad-vanced skills in diagnosis and treatment,but also the friendliness and compassionthat nurses bring to health care.”On a typical day, Iannaco sees patientsranging in age from six months to over;; years old who have upper respiratoryproblems, sore throats or urinary tractinfections, as well as those who have cuts,sprains or athletic injuries. She ordersrapid strep-throat tests, urinalyses andpregnancy tests and interprets the resultsof EKGs and X-rays.

“It is important to get these patientson a treatment regimen before theirproblems escalate and cause seriouscomplications,” she says. “Continuity ofcare is also important. We line up spe-cialists if necessary and suggest primarycare providers who can help the patientstackle conditions like hypertension andelevated blood sugars.”The same sense of urgency drivesReyes at the Rutgers Community HealthCenter. “Our goal is to get patients intothe system,” says Reyes. “To encouragepeople who have been reluctant to seekcare, we build bonds with the commu-nity.” There are no medical doctors onsta;, but the center has agreements withoutside collaborating physicians whoreview patients’ charts and advise thesta; on treatment.

The center o;ers chair yoga, as well as
classes in management of asthma, diabetes, healthy eating and stress. The sta;
also conducts sessions to help patients
understand Medicare and Medicaid.

To achieve positive outcomes, the
sta; looks beyond test results to determine what the patient needs in order to
adhere to the treatment plan and adopt
the lifestyle changes that will promote wellness. In addition to multiple
chronic illnesses, some patients have
substance-abuse problems, mental
health disorders, limited incomes and
language di;culties.

Reyes cited the example of a patient
with diabetes who was in and out of the
emergency room.

“He wanted to stay on his medica-tions, but couldn’t read, so we gave him abox with di;erent-colored slots that en-abled him to take the medications at theright times,” she says. “Instead of advis-ing him to avoid eating rice, we locateda neighborhood store that sold low-costfruits and vegetables that he could a;ordto buy with food stamps.”Data shows that these interventionspay o;. From January to December